Congestive heart failure classification

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Heart failure
ICD-10 I50.0
ICD-9 428.0
DiseasesDB 16209
MedlinePlus 000158
eMedicine med/3552 
MeSH D006333

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Classification Schemes of Congestive Heart Failure

Framingham Criteria

Major Criteria

Minor Criteria

Boston Criteria of Congestive Heart Failure

  • Category I: History
  • Category II: Physical Examination
  • Category III: Chest Radiography

No more than 4 points are allowed from each of three categories; hence the composite score (the sum of the subtotal from each category) has a possible maximum of 12 points.

The diagnosis of heart failure is classified as "definite" at a score of 8 to 12 points, "possible" at a score of 5 to 7 points, and "unlikely" at a score of 4 points or less.

New York Heart Association Criteria (NYHA)

  • NYHA I: No symptoms with ordinary activity.
  • NYHA II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina.
  • NYHA III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
  • NYHA IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency present at rest.

ACC/AHA Classification of Chronic Heart Failure

Classification System based on structural and symptomatic stages of the syndrome.

Introduced to emphasize the natural history of the heart failure syndrome and to identify ealier opportunities to intervene and prevent advancement. (Use along with NYHA starting when symptoms develop (Stages C-D). Stage A: patients at risk of developing heart failure but who have no structural heart disease at present. Stage B: patients with structural heart disease but no symptoms. Stage C: patients with structural heart disease and symptomatic heart failure. Stage D: patients with severe refractory heart failure.

Stage A

Patients “at Risk”

Stage B

Patients with structural heart disease, but no history of signs or symptoms of heart failure.

Stage C

Underlying structural heart disease and symptoms of heart failure.

  • Dyspnea or fatigue due to left ventricular systolic dysfunction.
  • Asymptomatic patients receiving treatment for prior symptoms of heart failure.

Stage D

Despite of maximal medical therapy, symptoms of heart failure at rest and advanced structural heart disease.

  • Being considered for advance options including LVAD and heart transplantation
  • Requiring continuous inotropic or mechanical support
  • Recieving or being considered for palliative care/end of life care.

References

2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. JACC 2009;xx: xx-xxx. Template:SIB

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